Left ventricular assist stand-by for high-risk cardiac surgery

Area of Science:

• Cardiovascular Surgery
• Mechanical Circulatory Support
• Transplantation Medicine

Background:

• Heart transplant candidates with severe left ventricular dysfunction often require high-risk cardiac surgery due to donor organ scarcity.
• Long-term mechanical support devices can serve as a critical backup for postcardiotomy failure in these patients.

Purpose of the Study:

• To evaluate the feasibility and outcomes of high-risk conventional cardiac surgery with a left ventricular assist device (LVAD) on standby for heart transplant candidates.

Main Methods:

• 36 patients with impaired left-ventricular function underwent various high-risk cardiac surgeries between 1994 and the study period.
• Patients were supported with long-term mechanical assist devices (e.g., Novacor, HeartMate, DeBakey) on standby.
• Preoperative intra-aortic balloon pump insertion was performed in 13 patients.

Main Results:

• 31 patients underwent high-risk surgery; 5 had immediate device placement due to impossible revascularization.
• 6 patients experienced postcardiotomy failure and were immediately supported with a long-term assist system.
• Conservatively operated patients survived and improved functionally; 6 of 11 LVAD patients were bridged to transplantation.

Conclusions:

• High-risk conventional cardiac surgery combined with LVAD standby is a feasible and valuable strategy for heart transplant candidates.
• This approach provides a crucial safety net, potentially improving survival and bridging patients to transplantation.